This week I was on anesthesia service- both adult and 2 days of pediatric.
Anesthesia has a steep learning curve. Though I know a lot of the drug basics and have the basic human body physiology mechanisms engrained in this giant brain, applying them within a moments notice is more challenging than you’d think! Though I’ll probably never be formally tested on the things I learned this week, they are super relevant to understanding basic physiology and were a great brain exercise.
Here are some things that helped me tremendously during my week on service:
- OME videos : mostly from the “intern content“: bleeding, platelets, O2 delivery, IV fluids, plum HTN, sodium, potassium, preop. Just to name a few. Especially o2 delivery and IV fluids came in clutch for this week.
- The basics of anesthesia, author: Miller. Ok this book is a trillion pages long but my institution gives us the ebook access. It was super helpful when I wanted to narrow in on some topics. They were medium length reads, which helped me get the quicker down and dirty.
- A quick reference to critical care. You definitely utilize a lot of “medicine” in anesthesia. You need to know comorbidities and how they will effect the anesthesia process. Big ones I read on from this are renal failure, CHF, pulmonary hypertension, pregnancy, electrolyte disturbances, and MI. This guide is kinda firecracker-y in that it’s quick, to the point, high yield.
- Uptodate and pubmed. One of my patients had a right bundle branch block, one had a myositis, one was paraplegic, one was pregnant, one had pulmonary hypertension, a few had brain tumors, one we used a double lumen tube to deflate a lung. Reading on anesthetic choices in these situations was interesting. The pathophys of each of these situations effects anesthesia and the drugs you can use a lot.
- Skills I studied from NEJM website [if you don’t know about these videos, check them out!] and youtube, and then did in real life: ecg monitoring placement, intubation using Mac/Miller vs glidescope, procedural analgesia in kiddos, peripheral IV placement, urinary catheterization, NG tube placement.
- Things that could give you a leg up:
- understanding what each number on the two anesthesia monitors mean and why they are relevant.
- What is the basic med regimen for a rapid sequence induction.
- What is the basic med regimen for conscious sedation without intubation.
- How to bag someone before intubation but after they are no longer breathing for themselves.
- How to distract children from being scared of the oxygen mask and what flavor choices your institution has for the oxygen mask.
- Inhalation inductions vs IV inductions and why they matter.
- When you would use a double lumen ET tube and how it works.
- What drugs not to use if someone has a spinal cord injury or has a muscular disease (MD, myositis, etc.) and why (autonomic dysreflexia).
- How volume control changes in pulmonary hypertension.
- How obesity effects anesthesia management.
Again, super helpful to know your patients ahead of time.
Know the ORs your provider will cover so you can record the following about the patients for your rooms:
- Kg weight and BMI
- Most recent vitals
- Relevant labs- CK, renal stuff, LFTs, hgb, electrolytes
- Comorbidities….especially lung and heart pathologies, arrhythmias, etc
- Current med regimen, especially asthma, copd, bp control, and seizure prophylaxis.
- Med allergies and what happens to them when they take that med.
- previous anesthesia history and how they tolerated it. Easy mask? Easy intubation? Difficult airway? Laryngospasm history? If no anesthesia history, ask about family history of adverse anesthesia problems.
- For kids: preference of mask flavor, awake vs asleep IV placement, premedication needed?
- Blood type. Can’t hurt you to know this.
- Relevant anatomical differences – aka situs inversus, vascular malformations? This did come up a couple times for my patients.
Just a few tips and tricks! hope they are useful for you!
What do you want to read about next?